The Morning Meeting with Al Tompkins is a daily Poynter briefing of story ideas worth considering and other timely context for journalists, written by senior faculty Al Tompkins. Sign up here to have it delivered to your inbox every weekday morning.

This is exactly the news we did not want to hear right before families gather for a holiday season, but hospitals around America and in the UK are treating an increasing number of strep cases. And it is not just sore throats this time, these are severe cases.  

The CDC says it is monitoring the situation: “CDC is looking into a possible increase in invasive group A strep (iGAS) infections among children in the United States. iGAS infections include necrotizing fasciitis and streptococcal toxic shock syndrome.”

Group A strep is fairly common. Several million Americans get that infection every year.  But Group A” invasive” infections account for about 4,000 to 25,000 cases annually, according to the CDC and these invasive infections kills 1,500 and 2,300 Americans every year.  It is these invasive cases that are showing up in hospitals and the CDC does not yet know why.

CNBC reports:

Children’s hospitals in Arizona, Colorado, Texas and Washington told NBC News they are seeing higher-than-average numbers of cases this season compared to past years.

Dr. James Versalovic, the pathologist-in-chief at Texas Children’s Hospital in Houston, said his facility — the largest pediatric hospital in the U.S. — has seen “a greater than fourfold increase” in potentially invasive infections in the last two months compared to the same period last year.

Texas Children’s recorded around 60 cases in October and November, he said.

In the U.K., at least 15 children have died from invasive group A strep since mid-September. The U.K. Health Security Agency said in an advisory last week that cases tend to rise sharply in the new year but appear to have spiked earlier than expected.

Colorado Public Radio reports that two Colorado children have died of this invasive strep. The state health department says the children were not yet school-aged and that these were the first strep-related deaths in that state since 2018. In a typical year, two cases of invasive strep are reported in the Denver area. Already this year, doctors have diagnosed 11 cases. Many of the cases are showing up with respiratory symptoms that appear similar to RSV, flu or COVID symptoms.

(CDC)

The invasive strep can cause all sorts of complications beyond a sore throat. CNBC described other possible complications:

• Lower airway infections like pneumonia or emphysema, which are characterized by pockets of pus in the fluid-filled space surrounding the lungs. Early signs of such infections include fever, chills, difficulty breathing or chest pain.
• Skin infections like cellulitis or necrotizing fasciitis, also known as flesh-eating disease. Both conditions involve red, warm, swollen or painful rashes. Necrotizing fasciitis spreads quickly and can turn into ulcers, blisters or black spots.
• Streptococcal toxic shock syndrome, an immune reaction that can lead to organ failure. The condition often begins with fever, chills, muscle aches, nausea or vomiting and then causes rapid heart rate or breathing.

Colorado Public Radio spoke with state epidemiologist Dr. Rachel Herlihy:

If a child isn’t recovering the usual way over a cold or an ear infection, that’s the time when there’s a slightly increased risk of having a concern for a bacterial infection.

“And so that’s usually the time you wanna be reaching out to your doctor, your medical provider, just to, to make sure that there isn’t anything else that’s going on,” she said.

Sometimes these bacterial infections appear to be a more prolonged illness with higher fevers, so the child just doesn’t perk up and turn the corner like they might with a viral infection.

“So, if any of those sort of alarm bells are ringing in parents’ minds, really (they should) have a low threshold to go in and get your child checked out,” Rao said.

She said other things should trigger a parent taking a child to the emergency department:

• Persistent high prolonged fevers
• Signs of having difficulty breathing, like using a lot of their accessory extra muscles to help them breathe or breathing very quickly
• Not able to take food or liquids by mouth, or throwing up, with the risk of being dehydrated. 

“If they are looking lethargic or drowsy or difficult to rouse, there are certain emergency situations where you want to go straight to the emergency room,” she said. 

Sales of cold and flu meds soar, supplies get tighter

Earlier this week, it appeared that manufacturers of over-the-counter cold and flu medications might catch up with the overwhelming demand. It has not happened yet, but nobody is calling it a crisis. 

The Wall Street Journal reported:

Sales of cough and cold medications at U.S. retailers rose 35% in the four-week period ended Dec. 3 compared with the same period a year ago, according to a Jefferies analysis of Nielsen data. Spending on throat sprays and lozenges increased 56% in the period.

Some versions of top-selling brands, especially pain-relief treatments designed for children, are sold out on Amazon.com Inc. and the online sites of CVS Health Corp. and Walgreens Boots Alliance Inc. Some consumers are taking to social media to report problems finding medications.

Retailers and data-tracking firms say overall supplies remain healthy amid an increase in demand. 

Spokesmen for CVS and Walgreens said that their companies are working with manufacturers to ensure continued supply of medications. An Amazon spokeswoman said that the company is working to get sold-out items back in stock but that a number of cough and cold products is still available for fast delivery. 

Manufacturers of drugs in high demand on Wednesday said their plants were running nonstop.

Why do screenings only catch 14% of cancer cases?

The nonprofit research organization NORC at the University of Chicago reported this week that 14% of all diagnosed cancers are caught by a routine recommended screening test. The rest of the cases get diagnosed because the patient noticed a symptom or by medical care or imaging.

There are four kinds of cancer that the US Preventative Services Task Force recommends people be tested for: breast cancer, cervical cancer, colorectal cancer and lung cancer. These are the percentages of cancers that routine tests have detected, according to the report:

(NORC.org)

The report also shows state-by-state data with some stark differences in screening. Some of this might have to do with access to health care in rural areas.

(NORC.org)

And the report says there are significant differences in who gets diagnosed by screenings:

(NORC.org)

(NORC.org)

As if to punctuate the importance of cancer screenings, look at the data on prostate cancer: 77% of prostate cancers are detected by screening.

CNN reported on this report by providing some context:

Dr. Otis Brawley, an oncology professor at Johns Hopkins University, said he was not surprised by the findings in the new report – especially because some cancer screening tests can be improved in their performance.

“Everyone has been led to believe that screening is better than it actually is,” said Brawley, who was not involved in the new report. “We need to invest in research to try to find better tests.”

In the case of breast cancer, for instance, “clinical trials tell us screening prevents 25% of those destined to die of breast cancer from dying of breast cancer,” he said. “In the US, about 60% of women aged 50 to 70 get screened. That means we can only prevent about 15% of the deaths destined to occur. It also means a lot of patients are diagnosed with cancer after a negative screening test.”

There are a few caveats to this data. First, it has not been peer-reviewed or published in a medical journal, and second, the data is from 2017. But keep in mind that during COVID, especially in 2020 and 2021, cancer screenings declined because it was so difficult to get in to see a doctor or get routine screenings done. 

A note from Al 

The Poynter Institute gives employees the last couple of weeks of the year off the reenergize and replenish. As a result, my trusty editor, Paul Alexander, and I will publish a couple of times a week instead of daily. But we will be here if all heck breaks loose, especially with Congress struggling to pass a budget bill and potentially tens of thousands of migrants moving across the border when Title 42 expires next week, we will be here doing what we do. Try to get some rest.  You journalists have had one heck of a year. We need you.